Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 20123 | CO |
NPI | 1013974260 |
---|---|
Provider Name | Dr. James Russell Burcham III |
First Address | Aurora, CO 80011-6700 |
Second Address | Aurora, CO 80011-6700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 27/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01201235 | (05) | CO |
13595 | BLUE CROSS BLUE SHIELD (01) | CO |
920561 | EYE SPECIALIST (01) | CO |
E82849 | (02) |